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Case Study - Cultural Care Mr. comes to the department of cardiology for a scheduled admission.
Case Study - Cultural Care
Mr. F. comes to the department of cardiology for a scheduled admission. His cardiologist has referred him to the department because he has experienced an increasing sense of a burning feeling and pressure in his chest upon exertion. He reports for scheduled coronary angiography.
A catheter is inserted in his arm and advanced in the radial artery. During the procedure two stents are inserted in two coronary vessels. The procedure is followed by two hours of bed rest. The patient's coronary vessels exhibit high-grade occlusion and can only be unblocked partially with the stents.
His medical condition is noted: Arterial hypertension, non-insulin dependent diabetes mellitus, peripheral arterial occlusive disease, obesity, left-ventricular hypertrophy, status post-amputation of the forefoot in 2010, status post-strumectomy in 2011, and status post-cataract surgery in both eyes. The patient takes oral diabetes medication regularly. He measures his blood sugar twice per day and checks his blood pressure one to two times a day on both his left and right arm. He enters the values in a special notebook reserved for this purpose. He does not follow a special diet. By his own account, he likes to prepare and eat hearty home-cooked food.
Mr. F. underwent amputation of his right forefoot two years ago. This procedure was made necessary by a previous wound on the foot coupled with the effects of peripheral arterial occlusive disease. Following infection of the wound with Methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase, and after a long healing period of about one year, the wound is now closed. He has a medical pedicure regularly and his daughter, a qualified nurse, regularly checks the condition of his feet. She also previously helped her father to take care of his wound. Mr. F. uses a cane and moves fairly independently. He says that he can get around well without a cane at home, but uses one for extra safety. His apartment is located on the third floor and reached via three flights of stairs.
Mr. F. lives with his wife, his daughter, his son, the son's ex-wife, and his grandchildren in a four-family dwelling. At home he motivates and assists his wife, who has been diagnosed with depression. Following a cerebral hemorrhage, the wife is more frequently in a depressed state. In these phases she goes into seclusion, neglects her appearance, and does not look after her personal hygiene.
Mr. F. is a trained butcher and used to run a pub/restaurant. It is now managed by his son and Mr. F. often helps out. He is able to get dressed and attend to his personal hygiene himself. He only needs assistance when putting on his socks. When he is at home, his daughter helps him to put on his socks—a chore he cannot manage on his own because of his waist circumference.
Mr. F. is concerned that he might require a second operation on his foot. His daughter says that this has worried him for some time because of the long-term wound healing disorder and because it is very important for him to walk "like a man" (i.e., on his own two feet). In general Mr. F. gives the impression of having a strong personality, and he is convinced that life must always go on. His daughter says that he is highly motivated, which is a sharp contrast to her mother's behavior.
1. What are the cultural considerations needing the nurses' attention in each case?
2. Which cultural factors are most likely to influence some aspects of nursing care?
3. What things would you do to work with this family in a culturally sensitive way?
